How to Treat Pancreatitis Acute?

Things to note:

• Nil per mouth.
• Nasogastric suction when persistent vomiting or ileus occurs.
• Parenteral fluid replacement to correct metabolic and electrolyte disturbances.
• Parenteral nutrition support may be necessary.
• Drainage of abscess, psuedocyst, if required.

Medical Treatment:
For pain:

• Morphine, slow IV, 10-15 mg 4-6 hourly as required.

Acute symptomatic hypocalcaemia

• Calcium gluconate 10%, IV infusion, 10 mL as a bolus over 10 minutes.
• Follow with 60-120 mL diluted in 1 L sodium chloride 0.9%, administered over 12-24 hours.
• Monitor serum calcium at least 12 hourly.

If serum magnesium less than 0.5 mmol/L:
ADD

• Magnesium sulphate, IV infusion, 25-50 mmol in 12-24 hours.
• 1 mL magnesium sulphate 50% equal to 2 mmol magnesium.

Antimicrobial therapy
The administration of prophylcatic antibiotics to patients with severe necrotising pancreatitis prior to the diagnosis of infection is not recommended. For abscess of the pancreas, etc: Broad spectrum IV antibiotics, e.g:

• Ampicillin, IV, 1 g 6 hourly.

PLUS

• Gentamicin, IV, 6 mg/kg once daily.

PLUS

• Metronidazole, IV , 500 mg 8 hourly.

When to refer:

• All patients with moderate or severe pancreatitis.